Objective To evaluate the clinical effectiveness and safety of gastrodin injection in the treatment of vertigo. Methods A multi-center, single-blind randomized controlled trial was designed to study 240 vertigo patients who were randomly allocated into the treatment and the control groups.Patients in the treatment group were treated with gastrodin injection 600 mg, intravenously guttae, daily for 7 days, while those in the control group were treated with betahistin 30 mg, intravenously guttae, daily for 7 days. All data were analyzed by SAS. CMH (Cochran’s and Mantel-Haenszel) method was used to compare the clinical effect between the two groups. Nonparametric statistics and t-test were used in baseline data analysis. Results ① The clinical effectivenes on vertigo: according to the intention-to-treat (ITT) analysis, the clinical control rate and effective rate in the treatment group (n=117) were 71.19% and 90.60%, respectively, while 54.17% and 77.50% were in the control group (n=120). A statistic significance difference was found between the two groups (P=0.005 and P=0.004 for control and effective rate respectively).According to the per-protocol population (PP) analysis, the clinical control rate and effective rate in the treatment group (n=116) were 72.41% and 91.38%, respectively, and were 54.70% and 77.78% in the control group (n=117). Statistic significance was found between the two groups (P=0.005 and P=0.004 respectively). ITT and PP analysis revealed similar results. ② The clinical effect on vestibular function: the clinical control rate and effective rate were 62.26% and 81.13% respectively in the treatment group (n=53), and were 42.37% and 76.27% in the control group (n=58). Statistic significance was found in the clinical control rate but was not found in the effective rates between the two groups (P=0.029 and P=0.504, respectively). ITT and PP analysis revealed the same results. ③ Adverse drug reactions (ADRs) were slight to moderate. ADRs rates were 8.33% in the treatment group (n=120) and 10.83% in the control group (n=120), respectively. No statistic significance was found between the two groups(P=0.538). Conclusions Gastrodin injection and betahistine injection are safe and effective drugs for vertigo; gastrodin injection is better than betahistine injection in relieving vertigo symptoms.
目的 比较单纯手法复位和手法复位合并口服抗眩晕药治疗良性阵发性位置性眩晕（BPPV）的短期和长期疗效。 方法 将2004年1月－2011年6月期间收治的236例BPPV患者随机分为两组，对照组112例采用单纯手法复位，观察组124例在手法复位基础上配合口服抗眩晕药治疗，两组均于1周和3个月后复查，并随访观察1年，且比较其疗效。 结果 观察随访1年后，对照组总治愈率92.86% (104/112），观察组治愈率为93.54%（116/124），两者比较差异无统计学意义。 结论 单纯手法复位和手法复位合并口服抗眩晕药治疗BPPV其疗效相当，但可作为BPPV患者的首选治疗方法。Objective To evaluate the short-term and long-term effect of canalith repositioning procedures with or without anti-vertigo drugs on benign paroxysmal positional vertigo (BPPV). Methods A total of 236 cases of BPPV that were treated with particle repositioning maneuver with medicine treatment from January 2004 to June 2011. The patients were divided into control group (112 patients, underwent canalith repositioning procedures) and observation group (124 patients, underwent canalith repositioning procedures with medication of anti-vertigo drugs). The two groups were reappraised after one week and three months respectively, and the follow-up duration was one year. Results The success rate was 92.86% (104/112) in the control group and 93.55%(116/124) in the observation group one year after the treatment. The difference between the two groups was not significant. Conclusion The effect of canalith repositioning procedures with or without anti-vertigo drugs on BPPV does not differ much from each other.
目的 探讨管石复位法（Epley法）和嵴顶耳石解脱法（Semont法）两种手法复位治疗后半规管良性阵发性位置性眩晕（BPPV）患者的疗效。 方法 收集2009年9月－2011年1月就诊的后半规管BPPV患者60例，依据随机数字表法平均分配到两个治疗组，分别采用Epley法和Semont法进行治疗，观察患者眩晕改善情况，并随访3～12个月。 结果 两种方法的治愈有效率在治疗后1、2、3周，3个月时差异无统计学意义（P＞0.05）。所有患者随访3～12 个月，均无复发，治疗后均无不良反应。 结论 两种方法治愈有效率相近。治疗时可先选用Epley法，疗效不佳，再选择Semont法。
【摘要】 目的 了解原发性良性阵发性位置性眩晕（benign paroxysmal positional vertigo，BPPV）的双温试验及纯音测听结果临床特点。 方法 2009年6月—2010年6月诊断为原发性BPPV患者54例，于手法复位前行双温试验及纯音听阈测试，分析原发性BPPV患者的双温试验、纯音测听结果的临床特点。 结果 40例患耳无半规管轻瘫，其病程为（4.25±2.75）周，14例患耳半规管轻瘫，其病程为（9.21±5.85）周，两组间平均病程差异具有统计学意义（t=4.235，Plt;0.05）；39例后半规管BPPV中11例患耳半规管轻瘫，15例水平半规管BPPV中3例患耳半规管轻瘫，两组患耳半规管轻瘫发生率无统计学意义（χ2=2.679，Pgt;0.05）；39例后半规管BPPV中16例患耳听力下降，15例水平半规管BPPV中7例患耳听力下降，两组患耳纯音测听异常率无明显统计学差异（χ2=0.141，Pgt;0.05）。 结论 原发性后半规管BPPV与水平半规管BPPV半规管轻瘫及纯音听阈异常发生率相近，病程长者更易出现半规管轻瘫。【Abstract】 Objective To investigate the clinical features of results of bithermal test and pure tone test for patients with idiopathic benign paroxysmal positional vertigo (BPPV), and discuss strategies for prevention. Methods A total of 54 patients diagnosed to have BPPV during June 2009 to June 2010 underwent bithermal caloric test and pure tone test before particle repositioning maneuver. Then, we analyzed the clinical features of the test results. Results The course of 40 patients with canal paresis (CP) was (4.25±2.75) weeks, which had a significant difference from the course of 14 patients with CP in the abnormal side, which was (9.21±5.85) weeks (t=4.235, Plt;0.05). Among the 39 patients with posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV), 11 cases of canal paresis were found in the abnormal ear, and of the 15 patients with horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV), 3 cases of canal paresis were found. There was no statistical difference in the rate of canal paresis between the two groups of patients mentioned above (χ2=2.679,Pgt;0.05). Sixteen out of the 39 PSC-BPPV patients and seven out of the 15 HSC-BPPV patients had hearing loss (HL) in the abnormal ear with no statistical difference between the two groups of patients in the incidence of hearing loss (χ2=0.141,Pgt;0.05). Conclusion The incidence of CP and HL in the abnormal ear of patients with HSC-BPPV and PSC-BPPV is similar, and patients with long course of disease are more likely to have CP.
ObjectiveTo study the etiology and clinical features of patients with ophthalmoplegia resulting in vertigo. MethodsWe retrospectively analyzed the clinical data of 45 patients with vertigo caused by ophthamloplegia treated between January 2010 and December 2013. The causes and features of the disease, treatment and outcome were summarized. ResultsAmong the factors responsible for ophthalmoplegia resulting in vertigo, myasthenia gravis (MG) took the first place (20/45, 44.4%), followed by Graves' ophthalmopathy (9/45, 20.0%), diabetes (5/45, 11.1%), intracranial infection (4/45, 8.9%), medial rectus injury (3/45, 6.7%), orbital tumor (2/45, 4.4%), and Lambert-Eaton Myasthenic Syndrome (2/45, 4.4%). In 36 patients, the lesions located in the neuromuscular junction or muscles (80.0%). The pathogenesis of ophthalmoplegia were almost all caused by systemic diseases (88.9%), and the occurrence of local ophthalmology diseases was fewer (11.1%). Etiological treatments achieved beneficial effects. ConclusionThe etiology of ophthalmology diseases resulting in vertigo is confusing. We should care more for patients with ophthalmoplegia caused by systemic diseases resulting in ophthalmologic vertigo without vision damage. Careful examinations and proper treatments for etiological factors are necessary in clinical options.
ObjectiveTo explore the pathogenesis of cervical spondylosis combined with cervicogenic vertigo, and to investigate the clinical results of anterior discectomy and fusion in treating the disease. MethodsA retrospective study was performed on 83 patients with cervical spondylosis myelopathy (n=60, 72%) or radiculopathy (n=23, 37.3%) accompanied by sympathetic symptoms such as dizziness between March 2008 and November 2012. The disease involved single segment in 29 cases, double segment in 50 cases, and triple in 4 cases. All the segments involved were treated with anterior discectomy and fusion. Vertigo alleviation was observed before surgery, 3 days after surgery, and during the final follow-up. Neurological status was evaluated by Japanese Orthopedic Association (JOA) score system and sympathetic symptoms were evaluated with vertigo symptom and function scoring system. ResultsThe average follow-up was 21 months (ranging from 12 to 30 months). Significant difference was observed between sympathetic symptom scores and JOA scores before surgery and 3 days after surgery or at the final follow-up (P<0.05), but no significant difference was found between the scores 3 days after surgery and during the final follow-up (P>0.05). ConclusionThe surgical effect for cervicogenic vertigo is often accompanied by the relief of spinal cord and nerve roots symptoms. Surgery is effective for cervical spondylosis combined with cervicogenic vertigo.
ObjectiveTo evaluate the effects and safety of ginkgo leaf extract and dipyridamole combined with betahistine injection for the treatment of vertebrobasilar ischemia with vertigo. MethodsThe Cochrane Library, Medline, Embase, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database and China Biology Medicine Databases were searched from their establishment to September 2015. We used the method recommended by the Cochrane collaboration to perform a meta-analysis on randomized controlled trails. ResultsSix studies were included. The results of meta-analysis demonstrated that ginkgo leaf extract and dipyridamole combined with betahistine injection for the treatment of vertebrobasilar ischemia with vertigo was superior to either ginkgo leaf extract and dipyridamole or betahistine injection in total effective rate[RR=1.21, 95%CI (1.08, 1.35), P=0.000 7; RR=1.17, 95%CI (1.05, 1.31), P=0.006]. ConclusionGinkgo leaf extract and dipyridamole combined with betahistine injection is effective for the treatment of vertebrobasilar ischemia with vertigo. However, due to the limited quantity and quality of the included studies, the results need to be further confirmed.
Objectives To systematically review the efficacy and safety of bonesetting combined acupuncture in the treatment of cervical vertigo. Methods PubMed, CNKI, VIP, CBM and WanFang Data databases were searched to collect randomized controlled trials (RCTs) on bonesetting combined acupuncture in the treatment of cervical vertigo from inception to February 15th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed by RevMan 5.3 software. Results Eighteenth RCTs involving 1 915 patients were included. The results of meta-analysis showed that, compared with acupuncture or bonesetting alone group, the effective rate in bonesetting combining acupuncture group was higher (RRacupuncture=1.17, 95%CI 1.12 to 1.23, P<0.000 01; RRbonesetting=1.16, 95%CI 1.10 to 1.23, P<0.000 01). Improvement of the cervical vertigo symptom and function in the combined group was better than that in the acupuncture group or bonesetting group (MDacupuncture=3.42, 95%CI 2.29 to 4.56, P<0.000 01; MDbonesetting=6.45, 95%CI 5.56 to 7.33, P<0.000 01). Average flow velocity of cervical vertigo basilar artery (BA) in the combined group was superior to the bonesetting group (MD=7.54, 95%CIP=0.02). 1.08 to 13.99, Conclusions Bonesetting combining acupuncture treatment of cervical vertigo in terms of effectiveness and function improvement are better than those of acupuncture alone or pure bonesetting. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
With the aging of the population, the incidence of benign paroxysmal positional vertigo (BPPV) and osteoporosis have been increasing year by year, and the incidence of BPPV in vertigo related diseases has also been ranked first. There are similarities in structure, formation and metabolic mechanism between bone and otolith, but there is no consistent conclusion on the relationship between BPPV and osteoporosis. This article summarizes the current situation of the research on the correlation between BPPV and osteoporosis, the common risk factors and the related co-occurring mechanisms, aiming to provide more ideas for the prevention and treatment of BPPV patients, and improve the prevention and treatment ability of the co-diseases in the elderly.